Evaluation of Difference between Skin Motion and Tumor Motion for Respiration Gated Radiotherapy

Kwon, Kyung Tae; Lim, Sangwook; Park, Sung Ho; Kwon, Soo Il; Shin, Sung Soo; Lee, Sang wook; Ahn, Seung Do; Kim, Jong Hoon; Choi, Eun Kyung

Abstract

Accounting for tumor motion in treatment planning and delivery is one of the most recent and significant challenges facing radiotherapy. The purpose of this study was to investigate the correlation and clarified the relationship between the motion of an external marker using the Real?Time Position Management (RPM) System and an internal organ motion signal obtained fluoroscope. We enrolled 10 patients with locally advanced lung cancer and liver cancer, retrospectively. The external marker was a plastic box, which is part of the RPM used to track the patient's respiration. We investigated the quantitatively correlation between the motions of an external marker with RPM and internal motion with fluoroscope. The internal fiducial motion is predominant in the caraniocaudal direction, with a range of 1.3~3.5 cm with fluoroscopic unit. The external fiducial motion is predominant in the caraniocaudal direction, with a range of 0.43~2.19 cm with RPM gating. The two measurements ratio is from 1.31 to 5.56. When the regularization guided standard deviation is from 0.08 to 0.87, mean 0.204 cm, except only for patients #3 separated by a mean 0.13 cm, maximum of 0.23 cm. This result is a good correlation between internal tumor motion imaged by fluoroscopic unit and external marker motion with RPM during expiration within 0.23 cm. We have demonstrated that gating may be best performed but special attention should be paid to gating for patients whose fiducials do not move in synchrony, because targeting on the correct phase difference alone would not guarantee that the entire tumor volume is within the treatment field.